Provider Demographics
NPI:1396971255
Name:SHIELDS, MOLLY DUDLEY (MD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:DUDLEY
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1355 CENTRAL PKWY S
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5057
Mailing Address - Country:US
Mailing Address - Phone:210-349-9300
Mailing Address - Fax:210-366-2558
Practice Address - Street 1:3903 WISEMAN BLVD
Practice Address - Street 2:SUITE # 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4417
Practice Address - Country:US
Practice Address - Phone:210-675-6724
Practice Address - Fax:210-675-1759
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP6271207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3233710-01Medicaid
TX302660YT1VMedicare PIN